Healthcare Provider Details

I. General information

NPI: 1619483591
Provider Name (Legal Business Name): DENISE MARIE URBANCZYK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50430 SCHOOL HOUSE RD
CANTON MI
48187-5910
US

IV. Provider business mailing address

50430 SCHOOL HOUSE RD
CANTON MI
48187-5910
US

V. Phone/Fax

Practice location:
  • Phone: 734-495-1722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: